Corneal disease is increasing in prevalence; fortunately advances in technique and technology now allow us to successfully treat many blinding conditions.
Advanced forms of Corneal Transplantation
- Complex forms of Penetrating Keratoplasty - combined with cataract and implant surgery, pupil reconstruction, ocular surface transplantation
- Complex new forms of Lamellar Keratoplasty:
A host of new and advanced corneal transplantation procedures now enable replacement of diseased layers of the cornea whilst retaining unaffected healthy layers - these procedures lead to better vision, safer surgery and much improved graft survival rates:
- Deep Anterior Lamellar Keratoplasty (DALK) - advanced techniques now enable removal of corneal scars and irregularities of the cornea without complete removal of the patient's cornea - this has major advantages in safety, and a much reduced risk of graft rejection
- Automated Lamellar Therapeutic Keratoplasty (ALTK) Advanced use of automated microkeratomes now allow much greater precision of surgery which can perform more precise surgery, leading to greater refractive accuracy, safety and improved visual outcomes. This surgery may also be used to safely restore vision in patients who have had complications from lasik and refractive surgery such as excessively thin corneas and scarrring
- Descemets Stripping Automated Endothelial Keratoplasty (DSEK)
Also known as EK (Endothelial Keratoplasty), DSAEK is the latest revolution in corneal transplantation in which only the damaged inner layer of the cornea is replaced. The procedure has major advantages over conventional corneal transplantation:
- this is a new form of keyhole or small incision surgery, in which the operation is performed only through a small (5mm) incision -this leads to much improved safety, and strength of the eye)
- most (95%) of the patient's own cornea is not replaced, and only a thin layer of donor cornea is needed to replace the innermost layer of the cornea. Advanced automated microkeratome instrumentation is used to split the donor cornea, so that only a microthin layer is inserted into the eye - as a result the risk of rejection after EK appears to be much less than conventional surgery.
- as opposed to conventional surgery, which requires up to 16 stitches on the cornea, no corneal sutures are needed - sutureless surgery means much improved quality of vision and much faster return of vision after surgery
- as the surgical procedure is now much safer (the whole eye is not laid open), the operation can now be performed under local anesthesia, and is a day surgery procedure, with no need for ward admission after surgery
- repeat transplantation, if needed, can be much more easily performed, with replacement of an new donor through the original wound which was made
New Forms of Pterygium Surgery
The latest innovation in pterygium surgery is Conjunctival Autografting using Fibrin Glue - this procedure uses fibrin glue to attach a conjunctival graft in pterygium excision - this procedure has the lowest rate of recurrence of the pterygium, provides an excellent cosmetic result, and is sutureless surgery, which greatly reduces patient comfort after surgery.